This position will be with Granite State Health Plan, a subsidiary of Centene Corporation.
Review requests for prior authorization of medical services such as surgeries, pain management, home health care.
At least two years clinical nursing experience. Experience utilizing medical management software programs.
Licenses/Certifications: RN, LPN or LVN required. Current state nursing license.
- Review provider requests through fax or telephone to ensure medical necessity for services requiring preauthorization.
- Utilize nationally recognized criteria to determine medical necessity of services requested.
- Refer provider requests appropriately to Medical Director when medical necessity of services is not met based on the criteria.
- Act as a clinical resource to referral staff
- Act as a liaison between the Provider and the Medical Director
- Data enters authorizations into the system.
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...